Audit Compendium: Public Health
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Audit Compendium Public health Audit reports published between 2014 and 2019 EN December 2019 Contact: www.contactcommittee.eu © European Union, 2019 Reproduction is authorised provided the source is acknowledged. Source: Contact Committee of the Supreme Audit Institutions of the European Union. For any use or reproduction of the following material, permission must be sought directly from the copyright holders: Figures 1, 6 and 8: © OECD/European Union, 2018. Figures 2, 3, 7, 9, 12, 13 and 14: © OECD. Figure 4: © World Health Organization (WHO). ISBN 978-92-847-4267-7 doi:10.2865/43442 QJ-04-20-049-EN-N Contents 3 Page Opening words 7 Executive summary 8 PART I – Public health in the EU 9 Public health – adding more years to life and more life to the years 10 EU health policy 11 Legal basis and responsibilities 11 Policy objectives 12 Funding 13 Public health in the EU Member States 13 Prevention and protection 15 Access to healthcare 19 The quality of health services 22 New technologies and eHealth 25 Fiscal sustainability and other financial aspects 29 PART II – Overview of work done by the SAIs 33 Introduction 34 Audit methodology 34 Audited period 34 Prevention and protection 36 Audit objectives 36 Main audit observations 37 Access to health services 37 Audit objectives 37 Main audit observations 38 The quality of health services 39 Audit objectives 39 Contents 4 Main audit observations 39 New technologies and eHealth 40 Audit objectives 40 Main audit observations 41 Fiscal sustainability and other financial aspects 41 Audit objectives 41 Main audit observations 42 Follow-up of audits 42 PART III – SAI reports at a glance 43 Prevention and protection 44 Belgium – Rekenhof / Cour des comptes / Rechnungshof 45 Flemish preventive health policy – assessment of policy performance 45 France – Cour des comptes 49 Preventing healthcare-related infections: the next steps 49 Poland – Najwyższa Izba Kontroli (NIK) 53 The prevention and treatment of type-2 diabetes 53 Slovenia – Računsko Sodišče Republike Slovenije 57 Tackling child obesity 57 Access to health services 61 Germany – Bundesrechnungshof 62 Health research needed to study the value of orthodontic treatment 62 Lithuania – Valstybės Kontrolė 65 The accessibility of healthcare services and patient orientation 65 Malta – National Audit Office 69 The general practitioner (GP) function – The core of primary healthcare 69 Portugal – Tribunal de Contas 73 Citizens’ access to healthcare in Portugal’s National Health Service 73 Contents 5 Romania – Curtea de Conturi a României 77 Developing health infrastructure at national, regional and local level to increase access to health services 77 European Union – European Court of Auditors 81 EU actions for cross-border healthcare: significant ambitions but improved management required 81 The quality of health services 85 Austria – Rechnungshof 86 Quality assurance for physicians 86 Denmark – Rigsrevisionen 90 Report on differences in the quality of care across Danish hospitals 90 Ireland – Office of the Comptroller and Auditor General 93 Managing elective day surgery 93 New technologies and eHealth 97 Bulgaria – Сметна палата на Република България 98 eHealth 98 Estonia – Riigikontroll 102 State activities in implementing the eHealth system 102 Latvia – Valsts Kontrole 106 Is the “eHealth in Latvia” project a step in the right direction? 106 Fiscal sustainability and other financial aspects 110 Czech Republic – Nejvyšší kontrolní úřad 111 Funds spent by selected hospitals for the reimbursement of costs 111 Finland – Valtiontalouden Tarkastusvirasto 115 Trend projections for social security expenditure 115 Contents 6 Greece – Ελεγκτικό Συνέδριο 119 Horizontal thematic audit on the State’s arrears regarding hospitals, the National Organisation for Healthcare Services Provision (EOPYY) and a regional health directorate 119 Hungary – Állami Számvevőszék 123 Summary analysis of experience gained from audits of hospitals 123 Italy – Corte dei conti 126 Implementation of the extraordinary programme for building renovation and technological modernisation of the real estate properties of public health institutions 126 Luxembourg – Cour des comptes 129 Public financing of hospital investments 129 Slovakia – Najvyšší kontrolný úrad Slovenskej republiky 133 Public finances and property of healthcare facilities 133 Spain – Tribunal de Cuentas 137 The management and control of pharmaceutical benefits by the General Spanish Civil Service Mutual Insurance Company (MUFACE) 137 List of participating EU SAIs’ audit work related to public health since 2014 141 Acronyms and abbreviations 159 Glossary 162 7 Opening words Dear reader, The Contact Committee of the European Union supreme audit institutions (SAIs) provides a forum to discuss and address matters of common interest relating to public audit in the EU and its Member States. By strengthening dialogue and cooperation between its members, the Contact Committee contributes to effective external audit of EU policies and programmes. This also helps to enhance accountability in the EU and its Member States, and to improve EU financial management and good governance for the benefit of EU citizens. In 2017, we decided at our annual meeting in Luxembourg to make additional efforts to raise general awareness of recent audit work performed by EU SAIs. One year later, in 2018, we published a first audit compendium, setting out in a single document the work of EU SAIs on youth employment and the integration of young people into the labour market. In view of the success of this first edition, the Contact Committee decided to pursue the activity and address additional topics of general interest. We are therefore proud to present the second edition of the audit compendium, focusing on our recent audits of public health and related issues. Over the last few decades, the health systems in EU Member States have faced numerous challenges, such as ever rising costs and ageing populations, and patients as well as healthcare professionals are becoming more and more mobile across Member States. Therefore, public health requires coordinated efforts by the EU and all Member States and the topic will undoubtedly continue to demand a prominent place on the political agenda for generations to come. In the European Union, public health is largely the responsibility of the Member States. The EU mainly supports efforts undertaken at national level, with a specific focus on complementing or coordinating actions of the Member States in the area of public health. Consequently, public health, seen from an EU-wide perspective, is a complex area to audit. This edition of the compendium offers a general introduction to public health and the role of the EU and its Member States in this policy field, and provides an overview of selected audit work by EU SAIs since 2014, including a summary of their work. For more information about these audits, please contact the SAIs concerned. We hope you will find the audit compendium a useful source of information. Klaus-Heiner Lehne President of the European Court of Auditors Chair of the Contact Committee & Leader of the project 8 Executive summary I Public health is the science of preventing disease and prolonging lives. It affects people’s lives every day and in every part of the world. It is therefore on the political agenda of every modern society and will be for generations to come. II In the EU, public health is mainly the responsibility of the EU Member States. Therefore, health systems vary considerably across EU Member States. The European Union supports efforts at national level, with a specific focus on complementing or coordinating the Member States’ actions in the area of public health. III Consequently, public health, seen from an EU-wide perspective, is a complex area to audit. However, due to the importance of public health, the EU Supreme Audit Institutions have performed many audits on related issues. IV The first part of this audit compendium gives a general overview of public health in the EU, its legal basis, main objectives and related responsibilities. It also illustrates the main challenges currently faced both by the EU and its Member States in the area of public health. V The second part of this audit compendium summarises the results of selected audits carried out by 23 contributing Member State SAIs (Austria, Belgium, Bulgaria, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Poland, Portugal, Romania, Slovakia, Slovenia and Spain) and the European Court of Auditors over the past five years. These selected audits addressed important aspects of public health, namely preventive action, access to health services and the quality of those services, the use of new technologies and the fiscal sustainability of public health services. VI The third part of this audit compendium contains detailed fact sheets for selected audits carried out by the 23 Member State SAIs and the European Court of Auditors. 9 PART I – Public health in the EU PART I – Public health in the EU 10 Public health – adding more years to life and more life to the years 1 Health plays an important role not only in every modern society as a whole, but also for each of us individually. It is an important, if not the most important, determining factor for quality of life. 2 Public health, as defined by the World Health Organization (WHO), is “the science of preventing disease, prolonging life and promoting health through the organized efforts of society”1. It includes all activities aiming at maintaining or improving peoples’ health. 3 Besides being of value in itself, health is also an important economic factor. In Europe, as in almost all developed economies, public health is one of the largest and fastest growing areas of spending. Health and care workers represent around 8 % of the total workforce within the EU2. 4 Over the last few decades, European health systems have faced a number of challenges. Ageing populations have led to a growing demand for health services and a stronger focus on long-term care.